2001糖皮质激素诱导的骨质疏松症的预防和治疗指南(英文)美国风湿病学会.doc
《2001糖皮质激素诱导的骨质疏松症的预防和治疗指南(英文)美国风湿病学会.doc》由会员分享,可在线阅读,更多相关《2001糖皮质激素诱导的骨质疏松症的预防和治疗指南(英文)美国风湿病学会.doc(8页珍藏版)》请在三一办公上搜索。
1、Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis2001 Update American College Of Rheumatology Ad Hoc Committee On Glucocorticoid-Induced OsteoporosisMembers of the American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis are as fo
2、llows. Lenore Buckley, MD, MPH: Medical College of Virginia, Richmond; Maria Greenwald, MD: Palm Springs, California; Marc Hochberg, MD, MPH: University of Maryland School of Medicine, Baltimore; Nancy Lane, MD: University of California San Francisco School of Medicine; Stephen Lindsey, MD: Ochsner
3、Clinic, Baton Rouge, Louisiana; Stephen Paget, MD: Cornell University School of Medicine, New York, New York; Ken Saag, MD, MSc: University of Alabama School of Medicine, Birmingham; Lee Simon, MD: Harvard University School of Medicine, Boston, Massachusetts.The American College of Rheumatology is a
4、n independent professional, medical, and scientific society which does not guarantee, warrant, or endorse any commercial product or service.Address correspondence and reprint requests to American College of Rheumatology, 1800 Century Place, Suite 250, Atlanta, GA 30345. Submitted for publication Mar
5、ch 19, 1999; accepted in revised form April 11, 2001.Funded by:Merck & Co., Aventis Pharmaceuticals, Wyeth Ayerst, Bristol-Myers Squibb, Procter & Gamble, La Jolla Pharmaceuticals, Amgen, Novartis Pharmaceuticals, AstraZeneca Pharmaceuticals, Forest Pharmaceuticals,Abgenix, Vertex, G. D. Searle & Co
6、., PharmaciaGlucocorticoid therapy is associated with a number of significant side effects, of which bone loss resulting in glucocorticoid-induced osteoporosis and an increase in fracture risk is the most serious (1-4). However, studies show that many patients treated with glucocorticoids do not rec
7、eive treatment to prevent bone loss (5-7). This suggests that physician awareness of bone loss and the increase in fracture risk caused by glucocorticoid treatment is low, and that there is inadequate information about the effectiveness of preventive treatment strategies.Glucocorticoids are used to
8、treat a wide variety of allergic and inflammatory diseases and are prescribed by a wide variety of physicians, both specialists and generalists. A recent survey revealed significant variability in physicians knowledge about glucocorticoid-induced osteoporosis, by specialty (8). While most physicians
9、 recognized that postmenopausal women have a high risk of fracture during glucocorticoid treatment, many reported that they did not routinely consider either hormone replacement therapy (HRT) or calcium and vitamin D supplementation. Physicians with the greatest experience with steroid therapy, such
10、 as rheumatologists and pulmonologists, were the most likely to report that they would prescribe preventive treatments, but the majority of other specialists reported taking no preventive measures. Even among rheumatologists, there is considerable variation in practice patterns regarding the use of
11、pharmacologic agents for prevention and treatment (9). Also, many physicians are unaware that men and premenopausal women also are at great risk for glucocorticoid-induced osteoporosis, despite the existence of published studies demonstrating this (10, 11).In 1996, the American College of Rheumatolo
12、gy (ACR) summarized available information about the pathophysiology, diagnosis, prevention, and treatment of glucocorticoid-induced osteoporosis and developed recommendations for clinical practice (12). Because of the recent publication and presentation of results of several randomized controlled tr
13、ials of agents for the prevention and treatment of glucocorticoid-induced osteoporosis, as well as systematic reviews and meta-analyses of previously published trials (13-16), the ACR appointed an ad hoc committee, the ACR Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis, to update these earl
14、ier recommendations. In addition, the Committee reviewed advances in the field of bone mass measurement and legislation that affects the availability of and reimbursement for this technology for patients receiving glucocorticoid therapy in the US.These recommendations are intended to educate and upd
15、ate physicians on the prevention and treatment of glucocorticoid-induced osteoporosis. The Committee emphasizes that the recommendations are not fixed, rigid mandates and recognizes that the final decision concerning the treatment regimen for an individual patient results from an informed discussion
16、 between the patient and his or her health care provider.Bone mass measurementThe US Congress passed the Bone Mass Measurement Act in 1997, and the Health Care Financing Administration published guidelines for its implementation in 1998 (17). Bone mass measurement is reimbursed by Medicare for 5 cat
17、egories of persons at risk for osteoporosis in general; one category specifically includes patients receiving long-term glucocorticoid therapy at doses of 7.5 mg/day. Bone mass measurement is reimbursed for any procedure approved by the Food and Drug Administration (FDA) for detecting bone loss; the
18、 effect of this rule is that all forms of bone mass measurement, except dual-photon absorptiometry, are covered by Medicare.The Committee recommends obtaining a baseline measurement of bone mineral density (BMD) at the lumbar spine and/or hip when initiating long-term (i.e., 6 months) glucocorticoid
19、 therapy. Longitudinal measurements may be repeated as often as every 6 months for monitoring glucocorticoid-treated patients to detect bone loss. In patients who are receiving therapy to prevent bone loss, annual followup measurements are probably sufficient. A review of the clinical considerations
20、 in bone mass measurement was recently published; this review discussed not only the interpretation of bone mass measurement with dual x-ray absorptiometry (DXA), but also the interpretation with other techniques including quantitative computed tomography (QCT), single x-ray absorptiometry, and quan
21、titative ultrasound of bone (18).Calcium and vitamin D In 1996, Buckley and colleagues reported the results of a 2-year randomized controlled trial demonstrating that calcium and vitamin D supplementation prevented bone loss in the lumbar spine and greater trochanter in rheumatoid arthritis (RA) pat
22、ients receiving long-term, low-dose glucocorticoid treatment (mean prednisone dosage 5.6 mg/day) (19). Patients who received placebo lost bone at a rate of 2% and 0.9% per year in the lumbar spine and greater trochanter, respectively, while patients who received 1,000 mg of calcium carbonate and 500
23、 IU of vitamin D daily gained bone at a rate of 0.7% and 0.9% in the lumbar spine and greater trochanter, respectively.Other data support the effectiveness of calcium and vitamin D supplementation in preserving bone mass in patients receiving regular glucocorticoid therapy. In a randomized placebo-c
24、ontrolled clinical trial of alendronate in the treatment of patients receiving glucocorticoids (median prednisone dosage 11 mg/day), bone mass at the lumbar spine was maintained in patients treated with placebo rather than alendronate who received supplementation with calcium at 800-1,000 mg/day and
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 2001 糖皮质激素 诱导 骨质 疏松 预防 治疗 指南 英文 美国 风湿病 学会
链接地址:https://www.31ppt.com/p-4984727.html